Ethical and Legal Implications of Prescribing Drugs

Ethical and Legal Implications of Prescribing Drugs

Ethical and Legal Implications of Withdrawing or Maintaining Ventilator Support for Healthcare Professionals and Patient’s Family in ICU for Ventilator-dependent Patient

Legal and ethical standards guide the practice and decisions of healthcare professionals during the delivery of care services. However, a lot of ethical and legal challenges arise, especially when handling critically ill patients. Patients at their end of life are majorly unresponsive. The interplay of ethics and the law challenges the decisions the healthcare professional and the patient’s family members make (Schiller et al., 2019). In this case, the ICU ventilator-assisted 72-year-old man presents legal and ethical challenges faced in the case of withdrawing or maintaining ventilation support for a patient upon the request of the patient’s family member for both the health care provider and the family members. Keeping or withdrawing ventilator support determines whether the patient lives or dies. It raises a moral argument on the patient’s right to life and right to die (Campbell & Hall, 2019).

The ethical and legal challenges arise as a result of the inability of the patient to communicate, compromising patient autonomy, the benefits of continuing with the current care provided, and shared decision-making. This scenario presents insights into the ethical and legal dilemmas and patients’ rights to withdraw from treatment and support during their end of life. It also presents the importance of healthcare professionals having discussions with family members on the decisions to make and the impacts of such decisions. The relative authority of the patient’s family members, their understanding of the legal and ethical codes, and their interpretation of the patient’s state are important in helping the healthcare professional make an ethical and legal decision. It highlights the need to identify the emotional outcomes of the decisions on the patient and the family members. The scenario also highlights the issues that contribute to ethical and legal complexities in health care.

Strategies to Address Disclosure and Nondisclosure for Ventilator-dependent Patients in ICU

The provisions of the Florida Medical Records and Patient Privacy Laws (§456.057, §395.3025, and §456.059); give patients rights and privileges to treatment information, situations, procedures, and other medical records related to their care plan. Disclosure and nondisclosure decisions must align with ethical principles in medical practices of autonomy, non-maleficence, justice, and beneficence. However, healthcare professionals are expected to consider the outcomes of decisions during the end-of-life state on the quality of life for both the patient and family members (Wallace et al., 2020). The healthcare professional, based on the provisions of the American Medical Association (AMA) Ethics Principles II, III, and IV (American Medical Association, n.d.), is allowed to withhold information if they feel the information and decision will likely cause serious physical and mental harm on the patient and their family. Based on the current case, the healthcare professional can address issues of disclosure and nondisclosure by consulting with the hospital management and considering the capacity of the patient and family members to make decisions and provide consent on the actions related to the case.

Consulting with the hospital management will involve a larger team of professionals who can assist in the process of decision-making. Inter-professional decision-making in ICU settings has improved information exchange, careful consideration of law, ethics, and options, and a jointly approved treatment decision (Michalsen et al., 2019). On the other hand, considering the decision-making capacity of the patient and family members can help highlight whether the family members understand the options, the consequences of the available options, and the related costs and benefits of each option.

Strategies an Advanced Practice Nurse can Use to Guide Decision Making in ICU and End-of-Life Scenarios

Decisions are a part of the treatment process. ICU decisions are critical to the patient and their family. As an APN, I can apply my nursing experience in similar situations combined with the existing nursing protocols to make clear decisions. Another strategy to guide the decision-making process is focusing on the status of the patient and their surrogates to make informed decisions.

Combination of experience and nursing protocols: Experience and nursing protocols enhance competency in the nursing practice and the ability to make clear decisions. Experience has been linked to the ability of nurses to integrate basic practice protocols in nursing into their practice (Nibbelink & Brewer, 2018). Experience and use of existing protocols will improve my confidence to make decisions that are beneficial to the patient and are considerate of the welfare of the family members.

Focusing on the status of the patient and state of the family– Understanding the status and state of the patient and their family is an essential element of making ethical and legal decisions in the presented case. This requires reviewing the patient’s health records, their progress with current treatment over time, and observing the family members during the treatment process to determine their emotional states. Understanding the status of the patient and their surrogates to make decisions aligns with evidence-based practice, which requires clinical practice and decisions to be based on existing evidence (Karlsson et al., 2019).

The Process of Writing Prescriptions and Minimizing Medication Errors

Medication errors are more likely to occur during the process of prescription and administration of medications (Suclupe et al., 2020). However, errors can be minimized throughout the prescription process. Firstly, the health care professional must collect the patient’s full name and other identifying information. Second, they must ensure that the patient’s health issue is well evaluated and the right tests obtained. The prescribing officer can then identify the specific therapeutic objectives of the medication. The next step is to determine the right drug therapy for the patient and health condition based on the available options. If pharmacological options are considered, the prescribing officer must clearly label the medication, its strength, dosage amount and the dosage period, and the frequency of taking the medication. For further clarity, the officer can define the route of administration. Finally, it is important to monitor the patient throughout the course of usage of the medication to evaluate the therapy and make decisions on refills or discontinuation. Notably, medication prescription technologies, such as the use of computers and related tools such as bar codes, have been noted to reduce medication errors (Lin et al., 2018).

References

American Medical Association. (n.d.). Withholding Information from Patients. Retrieved May 31, 2022, from https://www.ama-assn.org/delivering-care/ethics/withholding-information-patients

Campbell, C. S., & Hall, M. (2019). Focus: Death: Mortal Responsibilities: Bioethics and Medical-Assisted Dying. The Yale Journal of Biology and Medicine, 92(4), 733. /PMC/articles/PMC6913808/

Karlsson, A., Lindeborg, P., Gunningberg, L., & Jangland, E. (2019). Evidence-based nursing—How is it understood by bedside nurses? A phenomenographic study in surgical settings. Journal of Nursing Management, 27(6), 1216–1223. https://doi.org/10.1111/JONM.12802

Lin, J. C., Lee, T. T., & Mills, M. E. (2018). Evaluation of a Barcode Medication Administration Information System. CIN – Computers Informatics Nursing, 36(12), 596–602. https://doi.org/10.1097/CIN.0000000000000459

Michalsen, A., Long, A. C., DeKeyser Ganz, F., White, D. B., Jensen, H. I., Metaxa, V., Hartog, C. S., Latour, J. M., Truog, R. D., Kesecioglu, J., Mahn, A. R., & Curtis, J. R. (2019). Interprofessional shared decision-making in the ICU: A systematic review and recommendations from an expert panel. Critical Care Medicine, 47(9), 1258–1266. https://doi.org/10.1097/CCM.0000000000003870

Nibbelink, C. W., & Brewer, B. B. (2018). Decision-making in nursing practice: An integrative literature review. Journal of Clinical Nursing, 27(5–6), 917–928. https://doi.org/10.1111/JOCN.14151

Schiller, C. J., Pesut, B., Roussel, J., & Greig, M. (2019). But it’s legal, isn’t it? Law and ethics in nursing practice related to medical assistance in dying. Nursing Philosophy, 20(4). https://doi.org/10.1111/NUP.12277

Suclupe, S., Martinez-Zapata, M. J., Mancebo, J., Font-Vaquer, A., Castillo-Masa, A. M., Viñolas, I., Morán, I., & Robleda, G. (2020). Medication errors in prescription and administration in critically ill patients. Journal of Advanced Nursing, 76(5), 1192–1200. https://doi.org/10.1111/JAN.14322

Wallace, C. L., Wladkowski, S. P., Gibson, A., & White, P. (2020). Grief during the COVID-19 pandemic: considerations for palliative care providers. Journal of pain and symptom management, 60(1),e70-e76. https://www.sciencedirect.com/science/article/pii/S0885392420302074

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Ethical and Legal Implications of Prescribing Drugs

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